Medicare + Dental Benefits
There’s approximately 332 million people in the United States. Here’s how they get their insurance:
48.5% through their job (i.e., employment-based).
21.1% through Medicaid (i.e., lower income individuals).
14.3% through Medicare (i.e., 65 years and older).
8.6% don’t have insurance at all.
6.1% through direct-purchase (i.e., individual insurance plans purchased through state or federal exchanges).
1.3% through the military (i.e., TRICARE).
Approximately 46 million Americans receive their insurance through Medicare. It’s an incredibly popular and powerful benefit provided by the federal government. It grew out of a program initially signed into law in 1956 by President Eisenhower to provide medical care for families of people serving in the military. In 1965, under the leadership of President Johnson, Medicare expanded to provide health insurance to people age 65 or older (regardless of income or medical history). The program has shifted over time. But as a general matter, Medicare consists of four plans:
Part A (hospital, skilled nursing, and hospice services).
Part B (outpatient services).
Part C (Medicare Advantage - basically Medicare administered by private insurers like United, Humana, or BlueCross BlueShield).
Part D (prescription drugs).
Individuals enrolled in Medicare Part A/B/D can also purchase suppplemental insurance policies that provide additional coverage to help defray out-of-pocket expenses for specific types of services (e.g., dental, vision, enhanced hospital coverage, enhanced outpatient coverage, etc.).
Individuals enrolled in Medicare Part C have a bevy of plan options at their disposal to match their specific needs. Medicare Part C is completely separate from Part A/B/D.
It’s important to note that traditional Medicare (i.e., Medicare Part A/B/D) does not have any typical dental benefits. Those benefits are very limited to services that are an integral part of another covered procedure (e.g., jaw reconstruction, preparation for radiation treatment, examinations preceding kidney transplants or heart valve replacements). But Medicare Part A/B/D won’t pay for things like 6-month checkups, x-rays, periodontal maintenance, fillings, crowns, etc. That’s a bummer! But such is life…
If you’re a dork like me, you may have read about some proposed rule changes that would increase the type of procedures for which Medicare would provide reimbursement. I was rapt. But as I digested the rule changes, I was disappointed to find that it’s still super limited in scope and wouldn’t cover the types of preventative services so many people need to maintain their oral (and overall) health. Over the summer, a group of democratic senators made the recommendation to add typical preventative dental services to traditional. It gained little traction and was tossed pretty quickly as part of the passage of the Inflation Reduction Act. That’s a bummer! But such is life…
So all that being said, traditional Medicare doesn’t include any dental benefits. You can buy a supplemental plan. Or you can enroll in Medicare Advantage. Or you can pressure your congressperson to try and pass a law that would enhance traditional Medicare to include preventative dental benefits. In the words of Max Weber, “politics is a strong and slow boring of hard boards”. If you want something, you gotta work at it.